epidural management postpartum

tntrn, ASN, RN · Oct 10, 2004

ON our unit, epidurals after a lady partsl delivery are turned off, usually before the placenta is delivered and sometimes before the baby arrives. Our recovery policy for vag deliveries is the same for all, regardless of what kind of pain management they have utilized. Q 15 X 4, then Q 30 X 2, then Q h X 2, then Q 4 then Q shift.

For c/s patients, the protocol is Q 5 until stable, (usually this goes longer because we're still in the PAC doing baby bath, paperwork, etc.) then q H X 6.

shay · Oct 10, 2004

I need some information about the monitoring of patients receiving epidural pain management after delivery. On our postpartum floor we are checking these patients every hour for 24 hours and according to some other hospitals in the area this is overkill. The anesthesia director wants some data. Where do I find that information or do any of you have a policy on epidural monitoring that has references?
Karen

Our hospital requires documenting respiratory rate and O2sat every hour for 24 hours if pt. rec'd epidural analgesia. I can't say whether or not it's overkill, as the other hospitals where I worked weren't exactly shining examples of following proper protocol and heeding AWHONN standards, so I am hesitant to use their examples as "the norm."

As far as where to find some research to back it up, if your hospital has a medical library, go there and get on medline or cinhal. You're bound to come up with something.

Sorry I couldn't be of more help.

KKRJJ · Oct 10, 2004

Thanks. So after the q 1h x 6 when the patients go the PP floor of if you do LDRP after csections do you check resp and LOC more than every 4h when they are on continuous epidural?

Karen

ON our unit, epidurals after a lady partsl delivery are turned off, usually before the placenta is delivered and sometimes before the baby arrives. Our recovery policy for vag deliveries is the same for all, regardless of what kind of pain management they have utilized. Q 15 X 4, then Q 30 X 2, then Q h X 2, then Q 4 then Q shift.
For c/s patients, the protocol is Q 5 until stable, (usually this goes longer because we're still in the PAC doing baby bath, paperwork, etc.) then q H X 6.

Pete495 · Oct 10, 2004

Although, I'm an Open Heart Nurse, we routinely get lung surgery patients back with epidurals in place. We are required to document pain level,resps. q1hr x 24 hrs, then q2hrs. We titrate for effectiveness. Infrequently patients have come back to our unit with a low resp. rate and somnolence, and we end up giving narcan. It doesn't happen very often, but it does happen. In my 2 years as a nurse, I've given narcan twice for these instances. However in both instances it was immediately on return from the recovery room. Because you are titrating for effectiveness though, you need to be aware of the patient's respiratory rate pretty frequently.

David

palesarah · Oct 10, 2004

ON our unit, epidurals after a lady partsl delivery are turned off, usually before the placenta is delivered and sometimes before the baby arrives. Our recovery policy for vag deliveries is the same for all, regardless of what kind of pain management they have utilized. Q 15 X 4, then Q 30 X 2, then Q h X 2, then Q 4 then Q shift.
For c/s patients, the protocol is Q 5 until stable, (usually this goes longer because we're still in the PAC doing baby bath, paperwork, etc.) then q H X 6.

We also recover women who had an epidural for a vag delivery the same as others- following delivery of the placenta, Q15x4, then Q30x2. If mom is stable at that point we transfer to postpartum standard of care (VS & assessment Q 8hr shift). In unstable, we continue q15 or q30 until stable (if had an epidural, needs to be able to move feet and get OOB with assistance) then transfer to postpartum SOC when she is stable.

We don't really even consider what she had for analgesia in labor after that point, unless she or the baby was negatively affected (such as mom has a spinal headache).

Very few of our pts are medicated with a continuous low dose epidural post-c/section, it's not a popular choice among our providers. Our scheduled sections actually just recieve a spinal, and don't even have an epidural cath placed at all. So they are recovered Q5 until they can move their feet, then (I think) Q15x4, Q30 x 2, Q1hrx2, Q4hr until 48hours out.

Now I'm curious is we're not dropping the ball somewhere with our vag delivered epiduarlized pts. I'll check our references and maybe have the hospital librarian do a literature search.

KKRJJ · Oct 10, 2004

Our vag patients when they come to the floor, generally are able to move if not they are soon and we help them until they can get up. Q1h vs and checks x 2 and then q4h post epidural x 24 h and then q shift.

It is the csections that I am trying to get fewer monitoring trips for. We do low dose epidural demerol for 18 -24 hours on the pp floor and are checking the patient , pain, loc, and resp every hour and the pump readings every 4..

karen

We also recover women who had an epidural for a vag delivery the same as others- following delivery of the placenta, Q15x4, then Q30x2. If mom is stable at that point we transfer to postpartum standard of care (VS & assessment Q 8hr shift). In unstable, we continue q15 or q30 until stable (if had an epidural, needs to be able to move feet and get OOB with assistance) then transfer to postpartum SOC when she is stable.
We don't really even consider what she had for analgesia in labor after that point, unless she or the baby was negatively affected (such as mom has a spinal headache).
Very few of our pts are medicated with a continuous low dose epidural post-c/section, it's not a popular choice among our providers. Our scheduled sections actually just recieve a spinal, and don't even have an epidural cath placed at all. So they are recovered Q5 until they can move their feet, then (I think) Q15x4, Q30 x 2, Q1hrx2, Q4hr until 48hours out.
Now I'm curious is we're not dropping the ball somewhere with our vag delivered epiduarlized pts. I'll check our references and maybe have the hospital librarian do a literature search.

KKRJJ · Oct 10, 2004

Our vag patients when they come to the floor, generally are able to move if not they are soon and we help them until they can get up. Q1h vs and checks x 2 and then q4h post epidural x 24 h and then q shift.

It is the csections that I am trying to get fewer monitoring trips for. We do low dose epidural demerol for 18 -24 hours on the pp floor and are checking the patient , pain, loc, and resp every hour and the pump readings every 4..

karen

We also recover women who had an epidural for a vag delivery the same as others- following delivery of the placenta, Q15x4, then Q30x2. If mom is stable at that point we transfer to postpartum standard of care (VS & assessment Q 8hr shift). In unstable, we continue q15 or q30 until stable (if had an epidural, needs to be able to move feet and get OOB with assistance) then transfer to postpartum SOC when she is stable.
We don't really even consider what she had for analgesia in labor after that point, unless she or the baby was negatively affected (such as mom has a spinal headache).
Very few of our pts are medicated with a continuous low dose epidural post-c/section, it's not a popular choice among our providers. Our scheduled sections actually just recieve a spinal, and don't even have an epidural cath placed at all. So they are recovered Q5 until they can move their feet, then (I think) Q15x4, Q30 x 2, Q1hrx2, Q4hr until 48hours out.
Now I'm curious is we're not dropping the ball somewhere with our vag delivered epiduarlized pts. I'll check our references and maybe have the hospital librarian do a literature search.

laurakoko · Oct 11, 2004

Nonclinically, but as a patient, I received duramorph for post op pain after my first c section. I hated it!! It made me scratch my nose off my face! At my second c section, I requested that they NOT give it, and they did anyway. I itched like there was no tomorrow. Nubain, Benadryl, nothing helped. :)

laurakoko · Oct 11, 2004

Nonclinically, but as a patient, I received duramorph for post op pain after my first c section. I hated it!! It made me scratch my nose off my face! At my second c section, I requested that they NOT give it, and they did anyway. I itched like there was no tomorrow. Nubain, Benadryl, nothing helped. :)

webbiedebbie · Oct 11, 2004

Wow...at the hospital where I work, an epidural vag delivery comes to our floor after the first hour. They are required to be able to walk before coming to us. We do an initial set of vitals when they come to us, but after that, the doctor orders routine vitals. So, they don't have vitals until the next shift...we work 12-hour shifts.

Our C/Sections get q 1 hr x 4, then q 4 hours until discharge. I really hate waking them up at 4 a.m. on the day of their discharge, especially if they are breastfeeding. Sometimes, if they are awake at 2 or 3 or 5 or 6, I will do them then.

webbiedebbie · Oct 11, 2004

Wow...at the hospital where I work, an epidural vag delivery comes to our floor after the first hour. They are required to be able to walk before coming to us. We do an initial set of vitals when they come to us, but after that, the doctor orders routine vitals. So, they don't have vitals until the next shift...we work 12-hour shifts.

Our C/Sections get q 1 hr x 4, then q 4 hours until discharge. I really hate waking them up at 4 a.m. on the day of their discharge, especially if they are breastfeeding. Sometimes, if they are awake at 2 or 3 or 5 or 6, I will do them then.